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2014 PREVENTION AND RECOVERY CONFERENCE Karen Orsi, Director Oklahoma Mental Health and Aging Coalition www.omhac.org [email protected] 405.858.2827 White House Conference on Aging scheduled for 2015 – possibly July • Coincides with 80th anniversary of Social security (1935) • 50th anniversary of creation of Medicare and Medicaid (1965 Social Security Amendments) OLDER OKLAHOMANS • Oklahoma is an aging state in an aging Country • Population over 60 growing; under 60 shrinking (U.S. Census) • 33% of population over age 50 • 20% over age 60 • 10% over age 70 • 4% over age 80 HEALTH RANKINGS Health of Oklahomans age 65 and over • Overall health ranking of 49th * • Ranks 46th in diabetes; Ranks 46th in smoking; 33rd in obesity * • 30th in multiple chronic conditions ; 47th in depression * • 92% live with at least one chronic health condition ** • 77% live with two or more conditions *America’s Health Rankings, United Health Foundation **Administration for Community Living, 2014 BEHAVIORAL HEALTH Behavioral health is a state of mental and emotional well-being and/or choices and actions affecting wellness. Behavioral health problems—such as depression, substance abuse and misuse, addictions and suicidal thoughts - are not a normal part of aging. Physical Health Chronic Diseases Addiction Mental Health Wellness Environments Medication Disability Support 6 BEHAVIORAL HEALTH Oklahoma • 2013- between 700,000 and 950,000 experienced mental illness or substance use disorder • Ranks 2nd nationally in both serious mental illness and any mental illness among adults • Ranks 46th in per capita spending on mental illness Older Adults • Reported frequent mental distress higher than regional and national rates • 17% of 50-64 reported frequent mental distress; 8% of 65 and older (2011 Behavioral Risk Factor Surveillance System) • State ranks 47th in depression for 65 and older (SOME) AGING ISSUES • Boomers • Older Adults • Even Older Adults • Health and Mental Health literacy • Fear of loss of independence • Long term care; long term supports; availability of community supports • Needing a Caregiver; being a Caregiver • Retirement security • Financial exploitation • • • • • • • • • • • • • Access Aging and disability – more vulnerable Lethal Culture, shame, secrets Ageism Depression Anxiety Substance use Chronic illnesses Pain Self medication Limited opportunities for intervention Medicare; supplements; enrollment BEHAVIORAL HEALTH ISSUES • Mental health disorders – depression, anxiety most prevalent • Substance use – alcohol, illegal substances • Medication misuse and abuse – prescription and over the counter • Abuse and neglect • Self neglect • Self medication • Trauma; safety • Dementia; cognitive issues; reduced capacity • Suicide • One in five (20%) experience mental health disorder; less than 40% get treatment; majority of treatment done by primary care physicians OLDER ADULT BEHAVIORAL HEALTH PROBLEMS Substance Abuse and Mental Health Administration Issue Brief 2013 Prevalence % with clinically significant anxiety 27% % with depressive symptoms 26% % using psychoactive prescription medication having abuse potential (pain, sleep, anxiety) 25% % with co-occurring alcohol and depression 20% % affected by a combination of alcohol and medication misuse 19% % at risk of problem drinking 16% OLDER ADULT SUICIDE • White males over 85 highest rate • Lethal methods • Access to firearms, medications, substances • 20% died by suicide on same day as PCP visit • 40% died by suicide within 1 week of visiting physician • 70% saw PCP one month prior • Link between depression and suicide; alcohol abuse • Poorly controlled pain • Higher rates of completion: 1per 4 attempts; 1 completion per 100-200 attempts in younger ages SUICIDE PREVENTION ACTION NETWORK SENIOR SUICIDE Risk Factors • • • • • • Depression Substance abuse Debilitating physical health problems Social dependency or isolation Family discord, losses Access to means Protective Factors • • • • Effective clinical care for mental and physical health and substance abuse Restricted access to highly lethal means Strong connections to family and community support Skills in problem solving and conflict resolution CONNECTEDNESS AND SUICIDE IN OLDER ADULTS • Family discord and social isolation (Beautrais, 2002; Rubenowitz et al, 2001; Duberstein et al, 2004; Harwood et al, 2006) • Having no confidantes (Miller, 1977; Turvey et al, 2002) • Living alone (Barraclough, 1971) • Not participating in community organizations or having hobbies (Rubenowitz et al, 2001, Duberstein et al, 2004) • Functional impairment/disability (Conwell et al, 2000, 2010; Duberstein et al, 2004, Waern et al, 2008) • Bereavement (Erlangsen et al, 2004; Conwell et al, 1990) Center for the Study and Prevention of Suicide (CSPS) University of Rochester School o f Medicine, Rochester, NY RESILIENCY FACTORS - WELLNESS • • • • • • • • Sense of meaning and purpose in life Sense of hope or optimism Spirituality – Religious practice Active social networks Support from family and friends Good health care practices Positive help-seeking behaviors Engagement in activities of personal interest • • • • • • CONNECTIONS Perceptions of friendships Church Neighborhoods Organizations Clubs Sports CIRCLING THE DRAIN OKLAHOMA INITIATIVES • Oklahoma Mental Health and Aging Coalition • Older Adult Behavioral Health State Plan • Older Adult Peer Support Specialty • MAPS Senior Wellness Centers • Oklahoma Aging Initiative • Integrating Aging, Health, Mental Health, Substance Use and Disability networks • Oklahoma Aging and Disability Resource Consortium OKLAHOMA’S OLDER ADULT ACTION PLAN • Lance Robertson, Executive Director, DHS Aging Services • Contract with OMHAC – 8/1/13 thru 9/30/14 • Development of 2 year Older Adult Behavioral Health Plan • Age 60 + • Excludes dementia diagnosis or treatment • No additional funding • Year one – general population • Year two – target specific subgroups • Development of Older Adult Behavioral Health State Plan Advisory Board diverse representation of networks • Mental Health, Addictions, Prevention, Recommendations/ Strategies 1 7 PREVENTION • Set of steps along a continuum to promote health, prevent mental health and addiction disorders, support resilience and recovery, and prevent relapse • Reduce the likelihood of developing a disorder • Delay the onset of a disorder • Reduce the severity of a disorder • Treat behavioral health as a public health issue like disease prevention or assuring quality drinking water 1 8 PREVENTION AND RECOVERY • QPR • Depression screenings • • • • PEARLS, Healthy IDEAS, IMPACT – evidence based programs 2 question screen 15 or 30 question self-administered Geriatric Depression Screening tool PHQ 9 (Patient Health Questionnaire) – clinician administered Suicide screenings Recognition of signs and symptoms Engagement, connectedness, resilience Ask critical questions About feelings About possible plan About reasons to live BARRIERS STRATEGIES • Network integration • Cross-training • Asking the right questions • Evidence based programs • Wraparound services for seniors (Systems of Care for Older Adults) SAMHSA – older adults not a special population • Medicare trainings for professionals SAMHSA – 2015-2018 Strategic Plan – older adults mentioned 2x in 40 pages • Education • Screenings • Diminish stigma / ageism • Unprepared system • Fragmented services • Funding • Workforce • Cultural Competence • Ageism • • OLDER AMERICANS BEHAVIORAL HEALTH TECHNICAL ASSISTANCE CENTER Older Americans Behavioral Health Issue Briefs Brief 1 – Older Americans Behavioral Health Series Overview Brief 2 – Aging and Behavioral Health Partnerships in a Changing Healthcare Environment Brief 3 – Screening and Preventative Brief Interventions for Alcohol and Psychoactive Medication Misuse / Abuse Brief 4 – Preventing Suicide in Older Adults Brief 5 – Prescription Medication Misuse and Abuse Brief 6 – Depression and Anxiety: Screenings and Interventions www.aoa.gov www.samhsa.gov 2 1 OLDER AMERICANS BEHAVIORAL HEALTH ISSUE BRIEFS Brief 7 - RE-AIM Implementation and Framework Brief 8 - Integration of Behavioral Health and Physical Health Care Brief 9 - Sustainability and Financing Brief 10 – Expanding Home and Community Based Services Brief 11 – Reaching and Engaging Older Adults Brief 12 - Behavioral Health for Caregivers Brief 13 - Rural Issues and Cultural Competence www.aoa.gov www.samhsa.gov Behavioral Health 2 2 CONTACT INFORMATION Karen Orsi | OMHAC Director | 405-858-2827 NorthCare | 4436 NW 50th, OKC 73112 [email protected] www.omhac.org • • • • • • • • Immediate Past Chair, State Planning and Advisory Council to the Oklahoma Department of Mental Health and Substance Abuse Services National Coalition on Mental Health and Aging – National Advocacy Committee Behavioral Health Advisory Council – Health Care Authority / ODMHSAS Older Adult Behavioral Health State Plan Advisory Committee ADRC Transformation Cabinet Olmstead Committee, ODMHDAS Healthy IDEAS trainer and coach QPR (Question, Persuade, Refer) Suicide prevention program trainer